Our eating habits change during the festive season. And one or two of us consume too much sugar. Nutrition coach and naturopath Heike Erner explains what sugar metabolism is and what connection exists between disorders of sugar metabolism and metabolic syndrome. The consequence of the four factors of metabolic syndrome (overweight, lipid metabolism disorders, high blood pressure, and sugar metabolism disorders) can be cardiovascular diseases.
Heike Erner has been a naturopath and holistic nutrition consultant since 2009, as well as a graduate business economist with a focus on personnel management/coaching. For 8 years, she has focused on nutritional counseling, health coaching, and micronutrient therapy. In addition, she consults and conducts research for companies in the nutrition sector regarding new, interesting findings from the field of naturopathy and nutritional medicine.
What is understood by sugar metabolism?
The body, as well as all organs and every cell, depends on sugar or glucose as an energy source. The sugar metabolism, also known as carbohydrate metabolism, thus has the physiologically important task of providing energy to the body and cells.
These are very complex processes involved in the absorption, conversion, and utilization of simple and complex sugars in the body. Wherever carbohydrates are involved, sugar metabolism is relevant. A distinction is made between various carbohydrates such as simple sugars (monosaccharides (like glucose)), disaccharides (e.g., table sugar, malt sugar, and milk sugar), or polysaccharides (in the form of complex carbohydrates such as those in potatoes, whole grain products, and legumes).
The hormone insulin
Sugar is metabolized when carbohydrates consumed through food are broken down in the gastrointestinal tract and released into the blood. Here, the pancreas and the liver, but also the kidneys, play a decisive role. The pancreas uses its hormonal component to control the blood sugar present in the blood. If this is too high, the hormone insulin is secreted by specific cells of the pancreas (beta cells).
Insulin ensures the uptake of sugar into the body's cells and lowers the blood sugar level. If blood sugar is too low, the hormone glucagon (from the alpha cells of the pancreas) acts as an antagonist to ensure that sugar is released from existing reserves in the liver.
While the pancreas takes over the hormonal regulation of blood sugar levels, the liver stores glucose (as glycogen) and can also produce glucose itself from non-carbohydrates when glycogen stores are empty (gluconeogenesis).
The kidneys also perform key functions in glucose metabolism. For example, they are responsible for recovering filtered sugar from urine for the body (reabsorption), so that urine is sugar-free in healthy individuals; furthermore, they produce some glucose themselves and use glucose for their own metabolism.
There are different forms of sugar metabolism disorders that must be strictly distinguished. For example, "diabetes mellitus" is merely a general term for an entire group of diseases that have a disordered sugar metabolism in common.
In the context of metabolic syndrome, we are speaking exclusively about insulin resistance and the resulting type 2 diabetes mellitus, which is typically a chronic disease that often has a nutrition-related cause and is closely associated with metabolic syndrome.
It is not to be confused with the equally well-known type 1 diabetes, which is caused by an autoimmune disease in which the affected person very quickly experiences an absolute absence of insulin production and must then inevitably substitute this hormone for a lifetime.
Why is sugar metabolism frequently disturbed in metabolic syndrome?
All four factors of metabolic syndrome are interconnected and interdependent. It is therefore easily explainable that obesity, for example, is often the first factor and usually arises from overnutrition, and is also closely correlated with an oversupply of, for example, carbohydrates in the diet as well as other unfavorable eating habits.
In the long term, this overnutrition also has a negative influence on blood sugar regulation. This in turn leads to a kind of "chronic overload" of the metabolism and ultimately not only to obesity, but in the long term also to resulting disorders of the sugar metabolism. This often results in further factors such as hypertension, often due to arteriosclerotic changes, which in turn have developed due to long-term elevated blood sugar levels.
This also explains why, with each new factor of metabolic syndrome, the probability of acquiring additional factors increases significantly. A vicious cycle that can only be countered with a decisive change in lifestyle!
When is the sugar metabolism disturbed?
The blood sugar value indicates the "sugar content" or the glucose share in the blood and changes depending on food intake. Newly occurring changes in blood sugar are usually determined and evaluated by a doctor during routine examinations.
Especially if existing risk factors such as obesity are present, and genetic predispositions for individual factors of metabolic syndrome are known, one should have blood sugar levels checked regularly by a general practitioner. The sooner changes are detected, the better one can counteract them.
Blood values
For initial orientation, the doctor looks at the following values, among others.
It is important to note: reference values can vary depending on the laboratory, they are subject to fluctuations, and must always be assessed by the doctor in the overall context with other values and over time.
The blood sugar value during a routine examination is usually determined in the morning before the patient has eaten anything. Different procedures are possible. The measurement can be stated in mg/dl or mmol/l. The standard values for the fasting measurement (plasma glucose) should be less than 100 mg/dl in healthy individuals. Values over 100 mg/dl up to 125 mg/dl are already referred to as prediabetes – here, the risk of developing diabetes can be increased. From a fasting plasma glucose of 126 mg/dl, diabetes may be present.
Another important blood value used for assessment is the HbA1c value. It measures, so to speak, long-term blood sugar. Our red blood cells (erythrocytes) contain the blood pigment hemoglobin. Glucose binds permanently to hemoglobin. Since our red blood cells are several months old before they are broken down, one can read the average blood sugar content of the last 8 to 12 weeks from them.
In healthy people, this value is below 5.7%. Between 5.7% and 6.4%, prediabetes may be present. Over 6.5%, there is a high probability of diabetes.
It is important that these values only have significance in the overall context and with repeated measurement. If a blood sugar disorder is suspected, the doctor will carry out further tests for clarification. The assessment of these values should therefore always be done by the general practitioner.
How does one notice a disturbed sugar metabolism?
Disorders, if not already known, are usually not noticed at all, and if they are, they are mostly recognized very late. Often when damage has already occurred and these cause problems as a result. Hence the clear recommendation, especially in the case of genetic predisposition or overweight, to have blood values checked regularly by your trusted general practitioner early on, even at a young age.
Your general practitioner will tell you what intervals for these blood tests make sense for you. As already described in other articles of the series on metabolic syndrome, metabolic syndrome and its factors are treacherous. The same applies to blood sugar disorders, which one initially does not notice at all. Only the resulting secondary diseases, such as vascular damage, cause problems.
However, if you should suddenly develop nonspecific symptoms such as excessive thirst, frequent urination, exhaustion, fatigue, frequent infections, nausea, or loss of appetite without a recognizable cause, it is advisable to have a medical clarification promptly to be able to rule out sugar metabolism disorders.
Changes in sugar metabolism are usually discovered by chance during a blood test as part of a routine examination. Timely countermeasures can often still prevent damage if diagnosed early.
What is understood by insulin resistance?
Insulin is a peptide hormone that is produced in the pancreas (more precisely, in the Islets of Langerhans located there – beta cells) and has the task of letting sugar from the blood into the body cells.
This happens according to the "key-and-lock principle." Simply put, insulin resistance means that the keys (insulin) that normally let glucose from the blood into the cells no longer work properly. One can also say, "the key" (insulin) suddenly no longer fits properly into the lock of the target cell and no longer opens it.
The consequence is that the production of the hormone insulin in the hormone-producing cells of the pancreas is constantly increased in an attempt to compensate for the insulin resistance or the lack of response at the target cells with even more insulin. However, this is pure stress for the insulin-producing cells of the pancreas, which become high-performance factories.
The longer this state persists, the higher the danger of developing chronic type 2 diabetes. One can say that insulin resistance is a precursor. This stage can often still be influenced by a corresponding change in lifestyle and diet.
What is understood by diabetes mellitus type 2?
Type 2 diabetes is the most common form of diabetes and a complex metabolic disease. It is the result of long-standing insulin resistance and is often part of metabolic syndrome. In the past, this form of diabetes was also referred to as "adult-onset diabetes." For the sad reason that more and more young people are also affected due to poor diet and exercise habits, this is no longer accurate today. The trend in industrialized countries is rising.
Type 2 diabetes is the result of insulin resistance and means that the cells have become "resistant" and let little or no glucose into the cell anymore. The consequences are chronically high blood sugar levels with results such as vascular and nerve damage, as well as the classic secondary diseases such as arteriosclerosis, strokes, heart attacks, kidney diseases, and many more.
As long as the cells are still letting just enough glucose from the blood into the cells, one can still influence the disease. Both through diet and medication. If insulin production fails completely, only the medical substitution of the hormone helps here too. In this stage, the type 2 diabetic also becomes an insulin-dependent diabetic.
Luckily, there are many upstream stages in which one can still consciously exert influence. If type 2 diabetes is in the initial stage, only an immediate and manifest change in diet and lifestyle helps. Sometimes medication is necessary. Medical advice is indispensable.
What can you do yourself to positively influence sugar metabolism?
If you already suffer from one of the factors of metabolic syndrome, obesity in particular should be mentioned here, or if you are aware of a genetic predisposition, you should place special focus on a healthy diet and lifestyle. Regular check-ups by a general practitioner are also indispensable at a young age if risk factors already exist.
There are basically three important influencing factors, which are also already known from the presentation of the other factors of metabolic syndrome. Healthy but at-risk people can do the following themselves to positively influence their blood sugar levels. However, a known type 2 diabetes always belongs in the professional hands of a doctor. In this case, every affected person should seek individual advice on what makes sense.
Nutrition:
Fiber-rich, fresh foods such as green vegetables are to be rated positively. The indigestible plant fibers have the effect that carbohydrates from food are absorbed more slowly into the blood. Furthermore, important vitamins and minerals are contained, which can have a positive effect. Overall, many fresh, plant-based, vitamin-rich foods are to be rated positively.
An exception is fruit-sugar-rich types of fruit such as grapes and bananas, as well as fruit juices or dried fruit such as figs.
People with healthy blood sugar levels should also only enjoy these in moderation, especially if obesity is already present. If insulin resistance is known or beginning, you should already completely avoid "sweet fruits" with high fructose content.
Beware of hidden sugar, especially in industrially processed foods. Who would suspect, for example, that an enormous amount of hidden sugar awaits the consumer in standard tomato ketchup? It is therefore always worth looking exactly at what is hidden in a ready-made food. It is best to replace it directly with fresh goods.
Weight loss:
A healthy, predominantly plant-based, and balanced diet also supports weight loss. Weight loss helps to improve the insulin sensitivity of the body cells. A long-term change in diet is important here. If possible, avoid, for example, carbohydrate-rich food in the evening. For this, it is often enough to simply avoid the side dish or replace it. Instead of potatoes, pasta, or rice, one can eat steamed vegetables as a side dish, for example.
Exercise:
Regular light endurance sports or an extensive walk several times a week helps to normalize sugar metabolism, increase insulin sensitivity, and reduce weight. Regular exercise also helps to reduce stress. Constant stress leads to the release of the hormone cortisol, which in turn leads to rising blood sugar levels.
It is important that you regularly seek advice and get checked by your general practitioner if insulin resistance or type 2 diabetes is already known. They may also recommend professional nutritional counseling. An individually created nutrition plan can in some cases be a helpful support and pave the way to normalizing blood sugar levels.
Conclusion
Sugar metabolism disorders encompass a number of different diseases as causes. In metabolic syndrome, insulin resistance and type 2 diabetes play an important role as one factor.
Mini-series in the online magazine on health and nutrition with nutritionist Heike Erner
Together with Ms. Erner, Medicom will provide simple health and nutrition advice in a mini-series to support the optimization of the individual factors. This allows everyone to individually adopt tips and advice for themselves. This does not replace a doctor's visit, but serves as motivation to find ways to begin a healthy lifestyle.
For each of the four factors of metabolic syndrome (overweight, sugar metabolism disorders such as type 2 diabetes mellitus, and lipid metabolism disorders such as elevated cholesterol levels), you will find an article with explanations and health-promoting advice.
We are convinced that everyone should and can do something actively for their health. Taking active responsibility for your own health means self-love and self-care and pays off twice in the end.
• Did you miss the interview with Heike Erner "Metabolic syndrome is treacherous"? You can read it here.
• Do you want to know how healthy eating works easily? Then listen to the podcast interview: This is how healthy eating works according to Anne Fleck.
